Benefits of laparoscopic surgery
Laparoscopic procedures provide many advantages to the patient over conventional open surgery. Some of the benefits of laparoscopic surgery are much less discomfort after the surgery since the incisions are much smaller, quicker recovery times, shorter hospital stays, earlier return to full activities and much smaller scars. Furthermore, there may be less internal scarring when the procedures are performed with laparoscopic surgery compared to standard open surgery.
At USC we have used new technology and advanced laparoscopic techniques to develop new laparoscopic operations for pancreas, liver and bile duct diseases. The laparoscopic hand-access device is a new laparoscopic device that allows the surgeon to place his hand into the abdomen during laparoscopic surgery and perform many of the different functions with the hand that were previously possible only during open surgery.
Laparoscopic surgery for the gallbladder and the bile duct
Laparoscopic gallbladder removal has been performed in thousands of patients throughout the world and is a very safe procedure. Gallbladder removal should be performed by laparoscopic surgery when possible.
In contrast to laparoscopic gallbladder surgery, laparoscopic procedures on the bile duct are rarely performed by biliary surgeons since they are technically very difficult. Since the bile duct is located deep in the abdomen the incisions for open bile duct surgery are long and large incisions. These incisions are usually associated with a lot of discomfort and require recovery period of 4 to 12 weeks. The majority of patients who undergo open surgery stay in hospital for 4 to 10 days after surgery compared to patients who undergo laparoscopic surgery and stay in hospital for 1 to 3 days after surgery.
Very few centers in the USA offer laparoscopic surgery for bile duct diseases. Laparoscopic surgery for bile duct diseases require expertise in advanced laparoscopic techniques and in complex open biliary procedures. These procedures are preferably performed in specialized centers that do a high volume of open and laparoscopic procedures by biliary surgeons skilled in bile duct surgery.
At USC we have developed specialized expertise in laparoscopic surgery for many uncommon bile duct disorders.
The laparoscopic procedures performed on the biliary system at USC are:
Laparoscopic cholecystectomy: In this procedure the gall bladder is removed by laparoscopic techniques. The usual indications for removal of the gall bladder for laparoscopic cholecystectomy include the presence of gallstones in the gall bladder and small benign tumors called gallbladder polyps.
Laparoscopic common bile duct exploration: In this procedure, stones in the bile duct are removed by laparoscopic techniques. In patients with gallstones small stones can pass from the gallbladder into the bile duct. Stones in the bile duct can cause obstruction leading to the development of jaundice and pancreatitis (inflammation of the pancreas). The treatment is removal of the gallbladder.
In many patients a stone that has passed into the bile duct is spontaneously excreted into the intestine. If a stone is found in the bile duct at the time of the gallbladder surgery then additional procedures are required to remove the stones. Stones in the bile duct can be removed at the time of the laparoscopic cholecystectomy by advanced laparoscopic techniques.
Laparoscopic bile duct bypass: In patients who have strictures (narrowing) of the bile duct, the drainage of bile into the intestine is blocked and the bile accumulates in the blood causing jaundice. Bile duct strictures can be caused by benign (non-cancerous) or cancerous conditions.
Benign bile duct strictures are usually from injury to the bile duct during a previous laparoscopic gall bladder removal procedure. In some patients inflammation from chronic pancreatitis can cause narrowing of the bottom of the bile duct. In selected patients we offer a surgical bypass procedure for bile duct strictures.
Resection of choledocal cysts: Choledocal cysts develop from abnormal dilatation of the bile duct that is usually congenital in origin. Choledocal cysts can lead to the development to of jaundice, pancreatitis and cancer in some patients if left untreated for many years.
The recommended treatment is removal of the choledochal cyst. The bile duct is then sutured to the intestine so that normal passage of bile is restored. In selected patients we offer a laparoscopic procedure for removal of the choledocal cyst.
Laparoscopic Whipple operation: We have developed a laparoscopic Whipple operation for selected patients with ampullary tumors.
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